Dr. Peter is no stranger to face masks. He regularly wears them during patient appointments at his pediatric dentist practice in Arlington, VA. For the last few months during this COVID-19 pandemic, he's been wearing a face mask in public too. Unfortunately, It's very difficult to understand the quality, construction, and protection that masks provide without a medical or scientific background. Keep reading to learn more than you'll ever want to know about the different options and different protection levels masks offer.
The first and more important definition we need to understand is the difference between a mask and a respirator. When we talk mask to protect against COVID-19, we are actually talking about a respirator which is pictured on the right below.
Mask:
These are designed primarily for one way protection (to capture bodily fluid leaving the wearer - in case of cough, sneeze, etc).
Primary design is NOT to protect the wearer.
Most do not have a safety rating.
Generally looser fitting and made of 2-3 ply with a melt blown layer in-between.
Respirator:
Tight fitting with a much better face seal.
Designed to provide two way protection (non-valve) but filtering both the outward and inward air.
Generally have stricter testing and safety ratings depending on how much they protect the wearer.
Respirator Standards:
The US Center for Disease Control (CDC) has stated that the N95 respirator is the gold standard of protection and advised personal protective equipment in their Covid-19 and SARS guidance. It is recommended to use at least an n95 or better for protection against respiratory viruses such as the two above. CDC FAQ. Although there is some debate as to the efficacy of other masks and the 'viral load' or exposure, there is little disagreement that the N95 or equivalent provides the highest level of protection against COVID-19 and other airborne illnesses,
N95, FFP3, FFP2, FFP1, what's the difference?
The American Standard of respirator protection is managed by the NIOSH (part of the CDC) and the most commonly known respirator in the US is the N95. Europe uses two different standards which include the FFP (filtering face piece) and P1/P2/P3 ratings. Both are managed by the CEN (European Committee for Standardization).
Here's the breakdown:
FFP1 filters at least 80% of particles that are 0.3 microns in diameter or larger.
FFP2 filters at least 94% of particles that are 0.3 microns in diameter or larger.
N95 filters at least 95% of particles that are 0.3 microns in diameter or larger.
N99 & FFP3 filters at least 99% of particles that are 0.3 microns in diameter or larger.
So what does that mean for protection? The closest European equivalent to the n95 is the FFP2 respirator, which is rated at 94%.
What about KN95s?
The Chinese standard of N95 that is supposed to have an equivalent specification to N95/FFP2 respirators. According to 3M: "It is reasonable to consider the Chinese KN95 as equivalent to the US N95 NIOSH respirators." The problem is there have been quite a few quality control issues with the KN95 respirators and the surge in demand has created a shortage. KN95 respirators generally use ear loops rather than behind head elastics which has a worse seal and there is no guarantee the mask you are receiving is actually meeting the Chinese standard: Counterfeit Respirators. Although it's safe to say KN95's will most likely do a better job of filtration than a t-shirt face covering, it's hard to know exactly how effective they are (especially if you are using a counterfeit model). When in doubt, check the CDC for an updated list to see if your respirator is approved or counterfeit here: CDC.
Valve Vs Non-Valve Respirators
Respirators with valves make it much easier to exhale air and makes them more comfortable to wear. The valve can also lead to less moisture build up inside the respirator but they do NOT filter the wearer's exhalation. This provides one way protection for the wearer but puts others at risk in situations like COVID-19. You'll never see these respirators used at hospitals or surgical centers because of this. With the shortage, it's possible this is the only kind of N95 mask in stock that you're able to find, and if that's the case, you can place a surgical mask or face covering over the valve to partially filter the exhaled breath.
What is a P95 Respirator and is it better than an N95?
In the USA, there are 3 ratings for protection against oils, N, R, or P. Although all of these masks filter the same, they have differing resistance to oil and are useful for different settings (usually industrial).
N95 - Not resistant to oil
R95 - somewhat resistant to oil
P95 - strongly resistant to oil (Oil Proof)
When working in an industrial setting, there may be oil particles in the air and this distinction is very important. If the mask does not carry a R or P rating, the oil may degrade and reduce the filtering capacity and performance of the respirator. For the vast majority of people trying to protect against Covid-19 or other respiratory viruses, any of these masks will be sufficient. Often times the R95/P95 is a different color (grey variety) but other than cosmetic differences, any of the "95" masks will be good for protection.
Are there any good sources for N95s or KN95s?
Right now, the US government and FEMA have reduced a lot of suppliers capacity to provide N95 and KN95 masks to the general public and are limiting shipments to medical personnel and hospitals only. Private practices (physicians offices, dentists, etc) are finally starting to get shipments (January, 2021) of masks they ordered in March 2020. If you are a particularly high risk person, elderly, or immunocompromised, we recommend reaching out to local sources and kindly asking for a supply if you're unable to find a proper N95.
A few of our recommendations that are currently in stock. Please note, N95s will offer the greatest protection against COVID-19.
1) Kimberly Clark N95 (Use these for high-risk environments or for the highest protection possible. The duckbill style tends to be much easier to breathe with for longer periods of time (though some people do not like the look). Beware of counterfeits.
2) Powecom Kn95 (These are quite comfortable but offer less protection than the above. They go around the ears as opposed to the headstraps and are available from multiple retailers.
3) U-Mask (international shipping, reusable to interchangeable filters): If you watch Formula 1, you may have seen some of these stylish masks donned by the teams. They will not offer as much protection as the n95s above but are much more comfortable and stylish for wearing outdoors/in lower risk environments. These are some of the highest-rated protection we've been able to find in 'fashion' masks.
4) Jaanuu Masks: This is a brand known for making high-end, comfortable scrubs and recently transitioned to using some of the same comfort and technology for face masks.
There are a number of other interesting designs and options out there but these are some of our favorites (Dr. Peter uses a 3M N95 (fit tested) in his pediatric dental office and wears the Umask linked above for all other activities). We have no affiliation with any of these options and will update the links and recommendations as things change.
What about homemade masks?
The CDC gave guidance on citizens using cloth or face coverings when in public if social distancing measures are difficult to obtain. Although shortages have become less widespread for surgical masks (N95's are still reserved and limited supply for healthcare and frontline workers), there are some things to consider such as materials when making your own mask.
image via smartairfilters.com
image via smartairfilters.com
It's important to note the differences in how various household mask materials compare in terms of effectiveness against particles. A study done by Cambridge University found the pillowcase and the 100% cotton t-shirt were the most suitable materials for an improvised face mask or face cover. Although certain materials such as a vacuum bag did have better filtration, they were very bad for breathability and thus, not recommended.
Here is a video from the US Surgeon General on how to make your own mask:
In Conclusion:
Hopefully we've been able to provide you with enough information to clarify the difference between N95, KN95, FFP2, FFP3, and surgical masks.
If you have any questions about immune support or some of the best supplements to take to stay healthy, read Dr. Peter's post on immune support here.
VK Pediatric Dentistry
5001 Lee Hwy, Arlington VA 22207
Schedule An Appointment Today in Arlington, Virginia at VK Pediatric Dentistry
If you haven't taken your child to a pediatric dentist yet or would like to schedule an appointment, Dr. Peter and the highly skilled team at VK Pediatric Dentistry are just a phone call away. Schedule an appointment online or call us today at 703-962-7814. We look forward to providing your children with a lifetime of healthy and happy smiles!